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Insurance indemnity and medico-legal support

We know doctors work hard to deliver good quality healthcare. But sometimes, things go wrong. If a patient has suffered harm as a result of a doctor’s negligence, it’s important that doctors have adequate and appropriate insurance or indemnity to compensate the patient.

This guide gives help to doctors, patients , employers and responsible officers/suitable persons, in understanding what insurance and indemnity means for them.

I’m a doctor, what does this mean for me?

You must make sure that you have adequate and appropriate insurance or indemnity arrangements in place covering the full scope of your medical practice in the UK. The cover you need is very much dependent on your circumstances.

For advice on the cover you need, speak to a medical defence organisation or another professional insurance or indemnity provider. Your employer or the organisation you are contracted to work for may also be able to help. We give some examples of the type of cover you may need below.

When you’re asked about your insurance and indemnity by a patient or someone you’re connected with professionally (your employer, responsible officer or designated body for example), you should be able to confirm that you hold adequate and appropriate cover.

We don’t hold a record of your insurance and indemnity details.

Insurance and indemnity when you work for an NHS trust or board or Health and Social Care (HSC) trust (in Northern Ireland)

If you work for a trust or board in the NHS (or for the HSC in Northern Ireland), the organisation you work for will receive indemnity through a clinical negligence scheme.

  • In England, indemnity is provided through the Clinical Negligence Scheme for Trusts (CNST), which is administered by the NHS Litigation Authority.
  • In Wales, indemnity is provided by Welsh Risk Pool Services.
  • In Scotland, indemnity is provided by the Clinical Negligence and Other Risks Indemnity Scheme.
  • In Northern Ireland each HSC Trust assumes the role, funded by the Department of Health, Social Security and Public Safety.

This applies even if you are a locum for an NHS trust or board (or for the HSC in Northern Ireland).

You should consider whether you need to take out additional personal insurance or indemnity for work that is not covered by NHS or HSC indemnity and to access personal regulatory and medico-legal support and advice. 

If you are treating NHS patients privately, you should check with your NHS trust employer what indemnity is in place.

Insurance and indemnity when you’re working privately (non-NHS or non-HSC)

If you carry out any private practice, you’ll need to arrange adequate and appropriate insurance or indemnity (even if this work takes place on NHS or HSC premises). This applies even if the work is in addition to work you do for a trust or board in the NHS or HSC.

Many independent healthcare providers will ask you for confirmation of your insurance or indemnity arrangements as part of their pre-employment checks. Some independent healthcare providers provide insurance and indemnity but you should always check that it gives you adequate cover for all of your work.

If you’re doing non-NHS or non-HSC private work in the UK but your EU wide insurance was arranged outside of the UK, you must make sure that:

  • your EU insurance or indemnity from outside the UK covers your work in the UK, and 
  • your EU insurance or indemnity is adequate and appropriate, and of sufficient value (at least the same value as a UK policy of insurance or with the same scope as a UK indemnity arrangement) to cover any claims made about your practice in the UK through the UK legal system.

I’m a GP

If you’re a GP (whether you are a partner or employed by a practice or healthcare organisation) or a locum GP, you’ll need to arrange adequate and appropriate insurance or indemnity. Or your employer may do this for you. 

I’m a locum

If you’re working as a locum for an NHS trust or HSC trust or health board, indemnity for the organisation will be provided by a clinical negligence scheme.

If you’re working as locum GP, or as a locum for a private healthcare provider, you’ll need to arrange adequate and appropriate insurance or indemnity for any work you do for that organisation.

As a locum you should check any contract or arrangement that you enter into to make sure you have adequate and appropriate insurance or indemnity in place.

Insurance and indemnity for medico-legal work

If you do medico-legal work (like providing advice, writing medical reports, or giving evidence in connection with a legal action, tribunal or hearing) and this work requires you to hold a licence to practise, you must take out adequate and appropriate insurance or indemnity.

What do you mean by adequate and appropriate?

The law says appropriate cover is cover against liabilities that may be incurred in practising as a doctor having regard to the nature and extent of the risks of practising as such. What constitutes adequate and appropriate is a complex area and you need insurance or indemnity that covers the full scope of your practice.

Medical defence organisations and other organisations in the commercial insurance market can advise you about what level of insurance or indemnity is adequate and appropriate for your practice. To get the best possible advice, you must give them accurate and up to date information about the scope and nature of your practice.

When should I review my insurance or indemnity arrangements?

You should do this at regular intervals and whenever your scope of practice, private practice income or employment or contractual arrangements, change.

The terms of your insurance or the scope of your indemnity protection may require you to tell your provider if certain things happen, such as sanctions being imposed on your registration or if you join the Specialist Register.

I’ve retired or stopped providing healthcare services – do I still need insurance or indemnity?

Patients who you saw whilst you were working as a doctor should not be left without a way of being compensated after you have retired or have stopped working.

You need to have appropriate arrangements to cover you for liabilities that arise from your practice as a doctor whenever a claim is brought.

Providing medical care in emergencies outside work (Good Samaritan acts)

The law only requires you to have insurance or indemnity for medical care you provide as part of your employment or self-employment. A Good Samaritan act (helping someone in an emergency situation) falls outside of this requirement. But you should check with your medical defence organisation, or insurer, to find out whether you have or need insurance or indemnity for any possible liabilities as a result of a Good Samaritan act.

Providing voluntary medical care (good neighbour acts)

Good neighbour acts include helping out, in your professional capacity, at a local sports club or similar planned voluntary work. You’re providing professional medical services whether they are paid or unpaid. If adequate and appropriate insurance or indemnity cover is not given by the organisation for which you are providing this service, you must make your own arrangements to cover yourself.

What is medico-legal advice and assistance – do I need it?

NHS and HSC indemnity schemes only provide indemnity to NHS/HSC bodies for clinical negligence claims. They won’t give you individual advice and help for other medico-legal matters from your clinical practice, such as criminal or disciplinary investigations. And they won’t give you individual advice or assistance if we’re asked to investigate your fitness to practise.

You may find it helpful to arrange medico-legal support to cover you in case you’re involved in an inquest where your trust is unable to support you, or an inquiry or if a complaint is made about you, especially if it is investigated further.

I’m a patient – what does this mean for me?

Doctors have a duty to confirm that they hold the right level and type of insurance or indemnity cover.

The type of cover that doctors have depends on:

  • where they work
  • whether they are employed or self-employed
  • the type of medicine they practise.

We do not keep a record of doctors’ insurance or indemnity arrangements. If you have a question about a doctor’s insurance or indemnity, you should ask them.

I’m an employer or responsible officer. What do I need to know about the insurance or indemnity requirements?

As an employer or responsible officer, you’ll probably know that doctors must have adequate and appropriate insurance or indemnity for their practice in the UK. We do not keep a record of the insurance or indemnity arrangements of individual doctors and there may be circumstances that we need to request this information from you.

The type of insurance and indemnity cover a doctor needs to hold depends on their individual circumstances, we’ve set out some examples below. If you are unclear about whether a particular doctor should have insurance or indemnity, you should discuss this with the doctor first.

If you’re an NHS or HSC employer

Indemnity for doctors employed by your organisation will be provided by a clinical negligence scheme.

  • In England, indemnity is provided through the Clinical Negligence Scheme for Trusts (CNST), which is administered by the NHS Litigation Authority.
  • In Wales, indemnity is provided by Welsh Risk Pool Services.
  • In Scotland, indemnity is provided by the Clinical Negligence and Other Risks Indemnity Scheme.
  • In Northern Ireland each HSC Trust assumes the role, funded by the Department of Health, Social Security and Public Safety.

If doctors in your organisation treat NHS patients on a private basis, you should ensure that they check whether this work is covered or whether they need to arrange their own insurance or indemnity.

If you’re a private healthcare provider

You should check with the doctors you employ or contract, if they will be covered by the organisation’s insurance or indemnity policy or if they need to arrange their own personal insurance or indemnity. 

If you’re a locum agency

If you place a doctor in a non-NHS or non-HSC post, you should make sure that they have adequate and appropriate insurance or indemnity in place. It may be helpful for you to confirm this information with the organisation that the doctor will be working for. 

If you’re a responsible officer or suitable person

As you will be making a recommendation about a doctor’s whole scope of practice, we would strongly advise that you satisfy yourself that the doctors who have a connection with you (for revalidation purposes) have adequate and appropriate insurance or indemnity in place for any medical work they do in the UK. Many responsible officers are doing this through the appraisal process where doctors are required to sign a probity statement that includes reference to ensuring adequate insurance or indemnity is in place.

It is the individual doctor’s responsibility to ensure that they have an adequate and appropriate insurance or indemnity arrangements in place.

We have set out a list of discussion points which you might find useful to gather assurance when you meet with the doctor. 

The statutory requirement for doctors to have insurance or indemnity

Good medical practice requires doctors to have insurance or indemnity in place where necessary.

We have regulatory powers to check whether doctors have adequate and appropriate insurance or indemnity.

We can:

  • check that any doctor practising in the UK has adequate and appropriate insurance or indemnity cover
  • remove a doctor’s licence to stop them from practising altogether, if we learn that they don’t have adequate and appropriate insurance or indemnity or if they fail to give us the information we ask for 
  • refuse to grant a licence to a doctor if they can’t assure us that they’ll have the adequate and appropriate insurance or indemnity in place by the time they start practising in the UK. 

A doctor must have adequate and appropriate insurance or indemnity in place when they start to practise medicine in the UK. Under the law, a doctor must have cover against liabilities that may be incurred in practising medicine having regard to the nature and extent of the risks. The type and level of insurance or indemnity a doctor requires depends on factors including where a doctor works, whether they are employed (and, if so by whom and for what services) or self-employed, and the nature of work they do.